BACKGROUND: In 2015, Utah mandated the reporting of negative hepatitis C virus (HCV) laboratory results from entities reporting electronically. Negative HCV laboratory results are stored in the Electronic Messaging Staging Area (EMSA) for 18 months and can only be accessed via electronic algorithms, thus providing confidentiality of the negative testing results. Utah has used negative HCV laboratory results to assist in the identification of acute HCV cases, which are critical to understanding current HCV transmission patterns and sources, by determining if any newly diagnosed HCV cases have recently seroconverted. We evaluated acute HCV cases identified in Utah since 2015 to determine the impact of electronic reporting of negative HCV laboratory results and our algorithm for identifying acute HCV cases through seroconversion.
METHODS: When new HCV cases are created in UT-NEDSS (Utah’s integrated disease surveillance system), EMSA is queried via electronic algorithms for any previous negative HCV test results to determine if the case has recently seroconverted. Negative test results matching the case are automatically added to UT-NEDSS and local health department investigators initiate an acute HCV investigation. For this assessment, acute HCV cases identified since 2015 were reclassified using the 2016 CSTE acute HCV case definition for standardization, and a method of identification was assigned as either “ELR identified seroconversion” or “other method”. The volume of cases was quantified by year and method of identification.
RESULTS: 8/31 (26%) and 27/52 (52%) confirmed acute HCV cases identified in 2015 and 2016, respectively, were identified through ELR identified seroconversion. In 2016, 52 confirmed acute HCV cases were identified in Utah (a rate of 1.8 cases per 100,000 population), a 68% increase from 2015. Although we identified considerably more acute HCV cases in 2016, the number of confirmed acute cases identified by other methods remained stable across the two years (23 cases in 2015, 25 cases in 2016). The average seroconversion window for acute HCV cases identified through ELR identified seroconversion was 5 months (range 1-11 months).
CONCLUSIONS: The collection and storage of negative HCV testing results electronically has allowed Utah to develop a comprehensive database of HCV screening test results. Electronic algorithms that search for previous negative testing improve the identification of acute HCV infections while protecting the confidentiality of the persons identified in the database.